论文部分内容阅读
目的探讨Hybrid手术镶嵌治疗儿童法洛四联症(TOF)的效果。方法术前介入治疗:3例有巨大体肺侧支(APCAs)的重症TOF在根治术前予以侧支血管堵塞术,其中2例采用国产动脉导管未闭封堵器堵闭体肺侧支血管,1例采用可控弹簧圈栓塞体肺侧支血管。术后镶嵌治疗:6例TOF根治术后残余分流,包括4例残余膜周部室间隔缺损(VSD),1例残余左室右房通道VSD,1例残余房间隔缺损(ASD)。对于VSD,首先建立动-静脉轨道,选择较缺损直径大2 mm的VSD封堵器,在超声心动图引导下将封堵器放置正确位置后释放封堵器;对于ASD,经股静脉置入鞘管至左心房,在超声心动图引导下将大小合适的ASD封堵器放置到位后释放封堵器。结果3例有巨大APCAs的重症TOF在根治术前予以侧支血管堵塞术后随即行外科手术,术后肺血明显减少,灌注肺症状消失,术程顺利,皆获得满意效果。随访1.5~2.0 a患儿发育正常。6例TOF根治术后残余分流者经导管封堵术封堵成功,心脏杂音消失。随访1~3 a无残余分流及心脏瓣膜异常,未出现心律失常,患儿生长发育良好。结论Hybrid手术治疗伴巨大APCAs及术后存在残余分流的TOF安全、有效。
Objective To investigate the effect of Hybrid surgery in pediatric tetralogy of Fallot (TOF). Methods Preoperative interventional therapy was used in 3 cases. Severe TOF with giant body pulmonary collateral (APCAs) was treated with occlusion of collateral vessels before radical surgery. Two cases were treated with patent ductus arteriosus occlusion , 1 case of control coil spring embolism pulmonary collateral vessels. Postoperative inlay treatment: residual shunt after 6 cases of TOF radical resection, including 4 cases of residual VSD, 1 case of left ventricular right atrium VSD and 1 case of ASD. For the VSD, first establish the arteriovenous orbit, select the VSD occluder larger than the defect diameter 2 mm, place the occluder in the correct position under the guidance of echocardiography and release the occluder; for the ASD, place it through the femoral vein Sheathing to the left atrium, the occluder was released after placing the appropriately sized ASD occluder under echocardiography. Results Three cases of severe TOF with huge APCAs were treated with collateral blood flow immediately before radical mastectomy. Surgery was performed immediately after operation. Postoperative pulmonary blood flow was significantly reduced. Infusion pulmonary symptoms disappeared and the procedure was successful. Both of them achieved satisfactory results. Follow-up 1.5 ~ 2.0 a children with normal development. 6 cases of TOF radical shunt residual shunt after successful closure of the catheter, heart murmur disappeared. Follow-up 1 ~ 3 a no residual shunt and heart valve abnormalities, no arrhythmia, children with good growth and development. Conclusion Hybrid surgery is safe and effective in treating TOF with huge APCAs and postoperative residual shunt.